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Home My WebLink AboutMattituck Park District ELIZABETH A. NEVILLE =�O Gy� Town Hall, 53095 Main Road TOWN CLERK H P.O. Box 1179 REGISTRAR OF VITAL STATISTICS �y • �� Southold, New York 11971 MARRIAGE OFFICER O Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ��,� .�� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3134 N Residential Non-Residential x Fee $ 25.00 Septic x Cesspool PERMIT ISSUED TO: Name : MATTITUCK PARK DITRICT Address 1: PO BOX 1413 City St zip MATTITUCK NY 11952 Descripton of Proposed construction or Alteration SANITARY SYSTEM FOR ONE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #C10-00-0015 Name Of Owner MATTITUCK PARK DISTRICT ------------------------------ Mailing Address 1 PO Box 1413 ------------------------------ ------------------------------ City St zip MATTITUCK NY 11952 -------------------- -- ---------- Property Address 1 11280 PECONIC BAY BLVD ------------------------------ ------------------------------ City St zip MATTITUCK NY 11952 -------------------- -- ---------- Tax Map No. section 126.00 block 6 lot 18.000 ------ --- ------ Cross Street BAY AVENUE ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 1/29/04 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) oS�FFo��c 313q ELIZABETH A.NEVILLE �O Gy� Town Hall, 53095 Main Road TOWN CLERK y P.O. Box 1179 REGISTRAR OF VITAL STATISTICS �y . �� Southold, New York 11971 MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ��l �� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK 20 TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: January 8, 2004 Transmitted herewith is a copy of application No. NR3271 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Mattituck Park District by G. Goehringer Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if this office may issue the permit. Please complete the form below and return it to me. * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. ��?a � f Signature o/ Dated DEC 29 '03 09:OGAM SOUTHOLD BUILDING 631 765 9502 P.2 ELIZARETR A. NEVILLE �� Town Hall, 58095 Main Road TOWN CLERK m P.O. Sox 1179 RIi;G18TRAEZ OF VITAL S"PATIBTIGS *a Southold, New York 11971 MARRIAGE OFFICER. Fax(881) 760-6146 , RECORDS MANAGEMENT OFFIOERTelephone(681) 765-2800 FREEDOM OF INFORM.ATJON OFFICER �l southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANTS Residential @ $10 or Non-Residential @ $25 Application No. j7) Permit No. Applicant Name Applicant Mailing Address / �z_ Septic Tank _or Cesspool BriefDescription of P oposcd Coils nlction orAltera 'o-6/ Ztzn / X ' — Location of Proposed Construetimi/Alte ti n. Owner of Property; f ✓ Owner Mailing Address: Owner Property`Address: Name and phorte number of contact person Tax Map No: Section _Block Lot Cross Street NOTE. LOCATION AP MUST BE SUB D WITH PL�A,T EW CONSTRUCTION REQUIRES SURVEY'WI HEALTH D AR E AP VAL gnature of Applicant Da ]Received by: Suffolk County Department of Health Services Approval for Construction-Other Than Single Family Reference No. C/'0 ^O o—o o IS- De / 7g Cfj) Project oF�/eF �'-Vr0& &r- �° Flow Q These plans have been reviewed for general conformance with Suffolk O/V/ County Department of Health Services standards, relatingto water supply and sewage disposal. Regardless of any omissions inconsistencies or lack of detail , , construction is required to be s, accordance with the attachedin standards,unless s �'�t conditions and applicable specifically waived by the Department.This approve _ g` expires 3 years from the approval to �sa_extended or wed. R_ -- 1 F �I�I� �`- - Pprov ate ewer i C?GNNFCT r9GL L-FACM/�VC,� Pdo�S' s�/Q CT rVC � � WATER LINES F'ltl�'T 7!: INSPECTED QY UE ' ___�__ S11F'r0LI �.'U% I ` Iz 'I. U9 1- Y41 J :NI~R�:ICES. P CALL `:?, 2 Gi-,7, e HC'Jt3� f � d ji EXCAVATION INSPECTION REQUIRED FOR SANITARY SYSTEM r BY MEALM DEPARTMENT �xi57rfvta VE ' APR 12043 CON RREN A. AC ?-q SULTINr r-I ; Z � D 4- Qi N y uv t FPO UTC r 074 urc. PotE �� UTL. ISLE`l' t r I , X1571 NG r ZW N - to +- I � _ -a ter,�-+�• �"'./ /� I"s•1� � �* �> � J � ' may- � . r -1n �+ f 4 C Pt J 011-�N A El A I L�b ff, aox o-g*l 44-t, i-A 0- Old 'kfw AV r . A&W ?C TI ON THJU 5 A H J 7A 9, y D Pv A I-4A Cl f- 17, ,4t. lc� tyls—I )kj t-i Tit